Multimodal treatment of cystic lymphangioma – A challenge

Abstract

Congenital cystic lymphangiomas or lymphatic malformations are benign malformations due to a developmental disorder of lymphatic vessels. The most frequent localization of lymphangiomas is the neck and head region. The fact that the lesions usually have no spontaneous regression, tend to augment in size and may cause life-threatening complications such as occlusion or infiltration of neighbouring organs and structures, underlines the need of an early adequate therapy. Surgical excision used to be the first-line treatment of lymphangiomas. However, complete excision often is not possible. Besides surgical excision, sclerosant therapy of these lesions by intracavitary injection of OK-432 (Picibanil®), a lyophilized mixture of group A Streptococcus pyogenes, is a common therapeutical option. We present two cases of lymphangioma which were challenging to manage, yet the results were good in one case and excellent in the other case (according to the Acevedo classification). Sclerotherapy with Ok-432 is recommended primary for macrocystic lymphangiomas. The application is safe and without serious side effects. It can be used alone or in combination with other treatment modalities.